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In Reply.—I have read with interest the comments of Watkinson regarding the management of thyroid nodules. The approach that he outlines in his letter is essentially the one that I would have advocated myself 10 years ago. The continuing development of fine-needle aspiration cytology, and my access to excellent cytopathologists has changed this approach, however. I now strongly advocate that fine-needle aspiration be used early on in the evaluation, especially of clinically suspicious or solitary thyroid nodules.
The other tests that Watkinson discussed (such as thyroid scintigraphy) we still use as adjunctive studies when the fine-needle aspiration does not provide conclusive evidence of malignancy. However, these tests are less specific and, in fact, more costly. When I made an estimate of the cost of Watkinson's diagnostic protocol in what I feel would be an average spectrum of 100 patients coming in for an evaluation of thyroid masses, I found
HOOVER LA. Surgical Strategy in Thyroid Disease-Reply. Arch Otolaryngol Head Neck Surg. 1992;118(4):448. doi:10.1001/archotol.1992.01880040115023
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